Provider Demographics
NPI:1497515779
Name:EDGEWATER PHYSICAL THERAPY GROUP
Entity Type:Organization
Organization Name:EDGEWATER PHYSICAL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMADZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-519-2958
Mailing Address - Street 1:THE PROMENADE
Mailing Address - Street 2:SPACE A3B
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020
Mailing Address - Country:US
Mailing Address - Phone:201-519-2958
Mailing Address - Fax:
Practice Address - Street 1:THE PROMENADE
Practice Address - Street 2:SPACE A3B
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020
Practice Address - Country:US
Practice Address - Phone:201-519-2958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty